The diagnostic path begins with pelvic exami-
nation, Pap test, and HPV testing, including HPV
DNA. COLPOSCOPY(examination of the cervix with a
special lighted microscope) provides additional
information about the location and extensiveness
of the cancer. Cervical biopsy (laboratory exami-
nation of tissue samples taken from the cervix)
provides definitive diagnosis. Diagnostic imaging
procedures such as COMPUTED TOMOGRAPHY (CT)
SCANor MAGNETIC RESONANCE IMAGING (MRI) may
show the extent to which the cancer has metasta-
sized to locations within or distant from the pelvis.
The pathologist determines the grade (degree of
abnormality of the cells) and stage (extent of the
tumor) from the biopsy tissue samples. STAGING
AND GRADING OF CANCERis important for determin-
ing appropriate CANCER TREATMENT OPTIONS AND DECI-
SIONS.cervical cancer 257BASIC STAGING OF CERVICAL CANCERStage Meaning Treatment Options
cervical intraepithelial cells are abnormal but precancerous and cryosurgery, laser surgery, loop electrosurgical
neoplasia (CIN2/CIN3) confined to a localized area of the CERVIX procedure (LEEP), or excisional conization to
remove abnormal cells
frequent and regular PAP TESTand COLPOSCOPY
CIN4/stage 0/carcinoma cancer remains confined to the cells of its cryosurgery, laser surgery, LEEP, or excisional
in situ origin conization to remove abnormal tissue
frequent and regular Pap test and colposcopy
stage 1 cancer remains confined to a small, clearly stage 1A:
defined area of the cervix total HYSTERECTOMY
stage 1A is microscopic; stage 1B is barely frequent and regular Pap test and colposcopy
visible to the unaided eye stage 1B:
modified radical HYSTERECTOMYwith SENTINEL LYMPH
NODE DISSECTIONand adjuvant RADIATION THERAPY
and/or CHEMOTHERAPY
or
high-dose external beam radiation combined with
internal seeding
stage 2 cancer has spread to other structures within high-dose external and internal radiation therapy
the pelvis but not to distant organs in combination with platinum-agent
stage 2A involves the upper VAGINA; stage 2B chemotherapy
involves parametrial tissue
stage 3 cancer has spread widely within the pelvis combination chemotherapy
and may involve the lower vagina and ureters palliative radiation therapy
stage 3A involves the lower vagina but not the clinical trials
pelvic wall; stage 3B involves the pelvic wall
or the pelvic LYMPHnodes
stage 4 cancer has spread to distant organs or recurred combination chemotherapy
(come back) after treatment palliative radiation therapy
stage 4A involves lower abdominal organs; clinical trials
stage 4B involves distant organs